Individual
EILEEN M DERKS-WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
2450 N 131ST ST, KANSAS CITY, KS 66109-3325
(913) 634-9760
Mailing address
2450 N 131ST ST, KANSAS CITY, KS 66109-3325
(913) 634-9760
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
78778
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
137300
REGISTERED NURSE
MO
01
—
14-74311-082
REGISTEREED NURSE
KS
01
—
78778
ADVANCE PRACTICE REGISTERED NURSE
KS
Enumeration date
06/30/2019
Last updated
06/30/2019
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